One of the Southland’s newest medical wonders is brown and likely to squirm when applied to a patient.
In this high-tech age of medical innovation, the lowly leech is staging a comeback. Once dismissed as medieval quackery, the use of leeches is becoming popular among Southern California surgeons who perform reattachments of fingers, toes and ears.
After microsurgery, the leech is used to ease blood congestion during the critical first days after reattachment. The process is a symbiosis of old and new, an example of how ancient and oft-scorned techniques can still have great value in 1990s medicine.
Leeches are now stocked as pharmacy items at hospitals like Torrance Memorial Medical Center and Long Beach Memorial Medical Center. Nurses have learned to apply the worms much as they might use bandages or creams--though not, perhaps, with the same nonchalance.
These are still leeches, after all, the same slimy creatures that sent chills and squeals through movie audiences when they attached themselves to characters in “The African Queen” and “Stand By Me.”
“These are the ugliest little creatures known to man. They’re totally repulsive. But they’re lovely, in that they save fingers,” said Dr. Roy Meals, associate clinical professor of orthopedic surgery at UCLA Medical Center.
Just last month, leeches were used in an attempt to salvage the finger of a Lomita carpenter after a saw accident tore three fingers from his left hand. The 61-year-old man was rushed to Torrance Memorial for 13 hours of surgery. After Dr. David Slutsky managed to replant one finger, leech therapy began.
At first, nurses applied fresh leeches hourly to the reattached finger. Even when the man was discharged, he returned each day to the hospital for outpatient leech treatment.
There, one morning in late August, physical therapist Tracey Mullan laid a leech on his swollen, blue-toned finger. She and her co-workers watched intently to see if the leech had begun feeding.
“He taking to it?”
“Did he attach?”
“No, he’s just trying to move his head. . . .”
Finally the team gave up on the first leech and fished a second candidate out of a jar. This time, the leech swiftly attached to the finger and began swelling, acquiring the shape and color of a Tootsie Roll.
The finger, meanwhile, was turning from bluish-gray to pink.
“Successful leech therapy!” Mullan announced triumphantly.
In fact, the patient reported that his hand felt better after the leech did its work.
“I’ll have a real dull ache--and after the leech treatment, it’ll go away,” said the carpenter, who asked not to be identified by name.
In the end, even hungry leeches could not save the man’s finger; Slutsky said last week it would probably be removed. Even so, the carpenter is grateful for the leech therapy.
“We gave it a good try,” he said.
The secret to the leeches’ success is best glimpsed in the finger’s color change from blue-gray to flesh-toned. That change graphically illustrates a leech’s role in easing the congestion that can often occur in a reattached finger.
The veins that normally provide drainage from a finger are difficult to mend surgically during a replant because they are small and as delicate as wet toilet paper, as one surgeon describes it. Without venous drainage, pressure in the finger can build rapidly, endangering its survival.
So a surgeon may turn to the leech, with its natural blood-sucking ability.
The leech draws about 5 milliliters of blood, and its saliva contains a natural anti-coagulant that guards against clotting and permits blood to ooze from the finger for many hours after the leech has finished feeding.
“The leech serves as a temporary safety valve,” said Dr. Randy Sherman, USC associate professor of plastic and orthopedic surgery.
Within days of successful surgery, newly grown blood vessels will allow blood to drain from the finger naturally.
Many of the leeches used in Los Angeles are flown here from Long Island, where a firm called Leeches USA in Westbury provides an 800 number and emergency delivery service to hospitals nationwide.
Formed in 1986, Leeches USA now sells more than 10,000 leeches annually, according to its president, Marie Bonazinga. The leeches sell for $6 apiece; the price drops to $4.75 for orders of 100 or more.
The new surge in leech popularity can be traced to the fact that the treatment has been found to work, Bonazinga said. “They cannot be used for all kinds of congestion, but for certain problems, like the reattachment of fingers and toes and ears, they work very, very well.”
Still, leech use requires a certain re-education of medical workers.
Torrance plastic surgeon Dr. James Wethe recalls the time five years ago that he first tried to order leeches from the pharmacy at Little Company of Mary Hospital in Torrance.
“I said, ‘I’d like some leeches. Can you get them?’ And there was this long pause. . . . They weren’t sure if it was a crank call.”
Patients, too, are sometimes stunned to hear a doctor recommend leeches.
“They’ve said, ‘Leeches? Why?’ They give you that scrunched-up face like, ‘You’re kidding me,”’ Wethe said.
Although several surgeons report they have never had a patient refuse leeches, few people--doctors, patients, nurses--express real fondness for the creatures.
“Everyone’s squeamish. Nobody likes those guys, especially when they drop off the finger and get lost in the bedsheets or fall on the floor. They’re disgusting,” Slutsky said, who nonetheless has used leeches on about 20 patients’ fingers since 1988.
One of those patients was David W. Fell, 34, a mechanic from Norwalk who was boating off Catalina Island in July, 1992, when his left hand became caught in a winch that operated the anchor. The winch crushed his ring finger and severed the little finger.
Fell was airlifted to Torrance Memorial, where Slutsky reattached the little finger and started leech therapy. Fell still remembers being awakened in the middle of the night so that a nurse could apply a leech.
He and the nurses quickly adjusted to the leech routine, even giving the creatures nicknames. And gradually, the finger healed.
Today, Fell still has his little finger, and he gives some of the credit to the leeches.
He would recommend leech therapy to others. Said Fell: “It’s not that gross that it’s worth not saving the finger.”
Medical History of the Leech
Fittingly, the leech is often called a bloodsucker. It is a worm equipped with suckers at both ends of its body. The front sucker contains a mouth and sometimes tiny teeth.
Most types of leeches live in fresh water. Some feed on animal blood and tissue, attaching themselves to their prey with the front sucker and sucking out blood. Their size can vary from less than an inch to eight inches long.
Since ancient times, leeches have been used for bloodletting. In 19th-Century France, thousands of leeches were raised on special farms. One Napoleonic-era surgeon would reportedly apply as many as 50 leeches at once on a single patient on the theory that the “bad blood” would be sucked out.
Today, leeches have gained new popularity among some plastic and reconstructive surgeons who use them to improve circulation after finger and tissue replants. They use a type of medicinal leech known as Hirudo medicinalis .
Sources: Encyclopedia Americana, World Book Encyclopedia, Los Angeles Times